Provider Demographics
NPI:1184357287
Name:CHRISUD LLC
Entity type:Organization
Organization Name:CHRISUD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:O
Authorized Official - Last Name:ITATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:346-260-5112
Mailing Address - Street 1:20320 NORTHWEST FWY STE 400
Mailing Address - Street 2:
Mailing Address - City:JERSEY VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5643
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20320 NORTHWEST FWY STE 400
Practice Address - Street 2:
Practice Address - City:JERSEY VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:77065-5643
Practice Address - Country:US
Practice Address - Phone:346-260-5112
Practice Address - Fax:832-376-7541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty